Abstract
Background: Acute pancreatitis sequelae require a multidisciplinary approach and ICU care. Ulinastatin is a serine proteases inhibitor that reduces inflammation by suppressing the infiltration of neutrophils and elastase release and inflammatory mediators that help improve clinical symptoms and reduce mortality. This study aims to evaluate the clinical utility of Ulinastatin. Methods: Fifty-two patients admitted to ICU with acute pancreatitis were divided into; Ulinastatin group who received a 3 to 5 days course of 200,000IU, and Control Group who didn’t receive ulinastatin. Pearson's Chi-square and Fisher's exact test were used and a p-value < 0.05 was considered statistically significant. Results: Mean age was lower among the Ulinastatin group at 43 years (p-Value 0.014) and Hepatic dysfunction was more among this group (p-value 0.04). Among new onset of organ dysfunction, only CVS dysfunction was significant among the Control group ( p-value 0.044) while respiratory function recovery (p-value 0.04) and coagulation profile improvement (p-value 0.017) was statistically significant among the Ulinastatin group. The mean duration of hospital stay was shorter among control group, 9.65 days vs 14 days, a p-value of 0.05and also the average duration of stay in MDICU was lower, 4 days vs 8.5 days, p-value 0.0044 in comparison to Ulinastatin group. Overall mortality incidence was 15.38%, 19% in Ulinastatin group vs 11.5% in Control group. Conclusion: This retrospective study is our experience in the use of Ulinastatin which has shown little efficacy in declining mortality and/or hospital stay duration though it helps prevent new organ dysfunctions.
Highlights
Acute pancreatitis(AP) is the sudden inflammation of the pancreas, clinically characterized by sudden onset of abdominal pain and elevated levels of pancreatic enzymes
This study aims to evaluate the clinical utility of Ulinastatin, a multifunctional serine protease inhibitor, in the management of severe acute pancreatitis and to evaluate for improvement on multiorgan dysfunction after the use of Ulinastatin
Fifty- two patients diagnosed with pancreatitis admitted to Intensive Care Unit (ICU) were included in this study
Summary
Acute pancreatitis(AP) is the sudden inflammation of the pancreas, clinically characterized by sudden onset of abdominal pain and elevated levels of pancreatic enzymes. The mechanism underlying the pathogenesis of severe acute pancreatitis is commonly believed to involve the abnormal activation of internal pancreatin due to various causes, resulting in damage to the pancreatic acinar cells and the release of inflammatory factors leading to a systemic inflammatory response.[1]. [2] the majority of patients with biliary pancreatitis recover without significant sequelae, 15–30 % of cases have severe episodes requiring multidisciplinary care.[3] The common complications are local (necrosis, pseudocyst formation, abscesses, hemorrhage) and systemic (pleural effusion, adult respiratory distress syndrome, renal insufficiency, multiorgan failure).[3, 4] If organ failure is not addressed within 48 hrs of onset it may lead to multi-system involvement and failure most commonly lung, kidney, and heart. This study aims to evaluate the clinical utility of Ulinastatin
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